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UWorld first pass Flashcards

1
Q

11B-hydroxylase deficency

A 
Female ambiguus genitelia
Hypertension 
HypoK
hyper NA
increased mineralocortocoids
decreased glucocorticoids
increased androgens
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2
Q

3 lead pacer placement

A

1- right atrium
2- right ventrical
2- AV groove (through the coronary sinus) to get to the left ventricle

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3
Q

3’ CCA tail

A

post transcriptional modification in eukaryotes (directly transcribed in prokaryotes)

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4
Q

74 - 93 nucleotides

A

tRNA

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5
Q

acute

A

Usually

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6
Q

Amatoxins affect?

Where do they come from?

A

RNA pol II which makes messenger RNA

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7
Q

beta blockers in hyperthyroid

A
  • Decrease sympathetic outflow

- Decrease the periferal conversion of T4-T3 by inhibiting iodothyronine deiodinase

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8
Q

Bioavailability

A

F/100 (IV is usually 100% bioavailability)


F= (areat under the oral curve x IV dose) /(area under IV curve x oral dose)

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9
Q

Cardiac output

A

CO=SV x HR

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10
Q

carnatine deficiency

A

Cannot shuttle fatty acids into the mitochondria and thuse B-oxydation cannot occur

Presentation: myopathy, weakness, myopathy, and hypoketoic hypoglycemia

synthasis of Acetoacetate is impaired

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11
Q

Cause of pulm edema in setting of aortic stenisos

A

Sudden decrease in left ventricular preload due to absent atrial kick caused by sudden afib

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12
Q

Central scomata

A

Scomata means darkness

macular leasions, demylination, diabetic retinopathoy, retinitic pigmentosa

macular degeneration can result of this with progressive loss of central vision because of lipid deposits in the macula

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13
Q

chronic

A

months to years

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14
Q

Class 1 A anti arrhythmics

A

Disopyramind, Quinidine, Procainamide (Double, Quarter Pounder)
Intermediate inhibition of phase 0 depolarization and prolonger effect of AP (QT) becayse of K+ channel block.

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15
Q

coronary arteriolar dialation

A

shunts blood away from ischemic tissue

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16
Q

Cryptococcal menigitis treatment

A

Amphotericin B

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17
Q

CSF in viral meningitis

A

Common microbes: enteroviurses

WBC: lymphocytes
Glucose: normal to mildly decreased

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18
Q

Damage to where causes hemiballism?

A

Subthalamic nucleus

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19
Q

Decrease calcium stones?


A

Potassium citurate. Citurate binds to ionized Ca2+

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20
Q

decreased binding to 2,3 BPG

A

Higher affinity of O2
HbF
Substitution of a lysine for a methionine causes familial erythrocytosis so the Hb doesn’t release O2 as well and have a decreased affinity for 2,3 BPG

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21
Q

Diphenoxylate

A

opiate anti-diarrheal that affects motility

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22
Q

dipyridamole

A

Coronary arteriolar dilation

shunts blood away from ischemic tissue

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23
Q

DNA pol I

A

remove RNA primers, 5’ exonuclease activity

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24
Q

dobutamine

A

B-adreneregic agonist with predominant B1 and min B2 and a1

Has a positive ionotrophic effect, weak posative chronotrophic effect

increases myocardial o2 consumption

**use in pts with MI complicated by cardiogenic shock

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25
Dobutamine
Increase cardiac contractility
26
EBV causes proliferation of:

Activated CD8+ T-cells that react to CD21
27
Embryologic structures effects in DiGeorge
``` 3rd and 4th pharangeal pouches C-cleft palate A- abnormal facies T- thymic aplasia C- cardiac abnormalities H- hypocalcemia (carpopedal spasms) 22 ```
28
external hemorrhoids
Painful squamous epithelium Innervated by branches of the pudendal nerve
29
Febrile seziure
treat with acetominophen
30
Fever, headache, myalagias, malase, cough, and core throat in school aged children
Influenza A
31
Findings of hyper aldosteroneism
hypokalemia High BP Hypernateremia
32
forign body infection
staph epideridis
33
gallstones during pregnancy
estrogen- cholesterol hyper secretion | progesterone- gallbladder hypomotility
34
germ tubes at 37 degrees
candidia albicans budding yeast most likely form of yeast with a central venous catheter Pseudohyphae with blastoconidia found in immunocompramised individules (HIV, TB) T-lymphocytes prevent the superficial spread neutrophils prevent hematoganous spread
35
Good pastures on Light microscopy
crecent formation==> rapidly progressive glomerular nephritis
36
Griseofulvin
P450 inducer
37
hartnup disease
defective intestinal and renal absorption of tryptophan | Tryptophan==> precurser for niacin and serotonin
38
Highly active antiretroviral therapy side effect
truncal fat redistribution Lipodistrophy of the face subcutanious fat, extremities, and buttoks primarly seen in patients taking stavudine and zidovudine
39
HIV patient wit brain mass with EBV genome
Primary CNS lymphoma
40
hydrochloric acid and alcohol after staining carbolfuchsin (aniline dye)
Acid fast stain
41
Hyperactue rejection
Min to hours Preformed antibodies against graft
42
hypersensativity reactions
type I- immidiate, atopic Type 2- cytotoxic antibody mediated type 3- immune complex Type 4- delayed type T cell mediated
43
Inhaled particals in the terminal bronchials are cleared mostly by:
ciliated cells
44
initial step in the pathogenisis of betathalassemia
mRNA mutation
45
internal hemorrhoids
columnar epithelium | innervation: inferior hypogastric plexus
46
isoproterenol
Non selective B adrenergic agonist B1- increase cardiac contractility B2- decrease systemic vascular resistance
47
Itraconazole and all azoles
CYP450 inhibitors | supress the synthasis of ergosterol
48
Lacuner strokes occur in the setting of?
HTN and DM
49
Layers to get to the bladder
``` Skin Superficial fascia aponeurosis Transversalis facia Bladder wall ``` **The bladder is extraperiteional and there for is not covered by peritoneum
50
Lactose intolerance
Lactase deficency | Galactosyl B-1,4-glucose ==> galactose is the step catalized by lactase
51
Medium containing vancomycin, colistin, nystatin, and trimethoprim
``` Thayer-Martin medium
 Vanco- inhibit gram +
 colistin- inhibit gram -
 Nustatin- inhibit yeast
 Trimethprim- inhibit proteus species ```
52
Metanephric mesoderm:

Distal convoluted tubules come from the metanephric mesoderm
53
methotrexate
Inhibits Buhydropholate reductase in the synthasis of thymidylic acid and purines Must suppliment with folinic acid
54
most anterior portion of the heart likelt injured in a penatrating trauma aiming posteriorly
RV
55
most frequent CNS tumor in immuno supressed patients
Primary CNS lymphoma caused by EBV virus
56
Myasthena gravis:

Diploplia, difficulty chewing, weakness and fatiguability of extraocular muscles that improves with edrophonium infusion Type 2 hypersensitivity: antibody mediated/cytotoxic distruction
57
nests of polygonal C cells with congo red deposits in the setting of a pheo
MEN 2A or 2B 
RET proto-oncogene
 Medullary thyroid cancer with extracellular amyloid deposits
58
occlusion of the anterior cerebral artery
loss of sensory and motor function in the contralateral leg | bilateral==> behavioral problems
59
order of antibody genes
IgM==> IgD==> IgG==> IgE==> IgA
60
P450 inducers
``` Phenytoin barbituatates rifampin carbamazepine griseofulvin ```
61
P450 inhibitors
``` ISN cinemtidine macrolids azoles grapefruit juice ```
62
Paget disease of the bone
Acceletated bone remodeling by osteoclasts Excessive RANK and NF-kB activation Bone pain, elevated ALK Phos in an elderly male patient
63
para-aminohippuric acid concentrations in the kidney
bowmens space
64
Phenytoin
P450 inducer | do not give with contraceptives
65
point mutation in sickle cell anemia
Valiene substilution for glutamic acid making the Hgl more sticky sickle cell crises==> exertinal dympnea, PNA, abdominal and bone pain
66
PSGN
Hypercellular glomeruli ASO antibodies C3 deposits
67
pyruvate carboxylase
Cofactor: bioten Action: pyruvate to OAA (1st step in gluconeogenisis
68
Pyruvate dehydroginase
Cofactor: thimine | Pyruvate ==> acetyl COA
69
Recurrent fever, dyspnia, and productive cough after an influenza A infection?
Staph aureus
70
relative erythrocytosis
dehydration normal RBC mass Polycythemia ***Pay attention to what meds the patients are started on
71
renal osteosystrophy
increased PTH Increase Phosphate increased Alk Phos Decreased calcium
72
Right peri-chiasmial leasion
A. right nasal hemianopia
73
Right ventricular hypertrophy
Primary pulmonary hypertension, pulmonary stenosis | READ THE QUESTION
74
rightward extention of the ventricular PV loop
increased ventricular preload | NS infucion
75
second most common cause of ring enhansing leasions in HIV patients
Primary CNS lymphoma- a diffuse large cell non-hodgkin lymphoma **Multiple leasions differentiates this from toxo
76
Serotoli cells
Secrete MIF | Lack of Serotoli: both male and female internal and just male external if child is XY
77
staph epidermidid virulance factor
Biofilms coagulase - staph extracellular pollysaccheride matrix barrier to antibiotics
78
steps of inflammatory leukocyte accumulation
Margination: increased vascular leakage Rolling: neutrophils roll on the endothelium binding to L-selectin on neutrophils or e/p- selectin on endothelial cells (cytokine stimulation) Activation: actavated integrins injuce conformational change necessary for binding Tight adheasion: neutrophils bind CD18 CD18 beta 2 integrins (Mac-1 and LFA-1), ICAM-1 Transmigration: Moving into the actual tissue requires PECAM01 found on peripheral ntercellular junctions of endothelial cells.
79
Symptoms of drug induced SLE:
-ANA and anti-histone antibodies present >95% of cases
-anti-dsDNA (rarely)
 exposure to: Hydralazine, procainamide, Isoniazide, minocycline, quinidine
80
Telomerase
Human reverse transcriptase Adds TTAGGG repeates Active in stem cells cancer cells upregulate there telomerase activity
81
Terbinsfine
Inhibition of squalene epoxidase treatment of dermatophytosis
82
THF
single carbon group donor in the synthasis of purines and pyrimidines
83
Thimine cofactor
Pyruvate dehydroginase: pyruvate -> acetyl CoA alpha ketogluterate dehydroginase Transketolase- in the hexo monophosphate pathway
84
Thiopentinal
Lipid soluable IV anesthetic that is rapidly distributed to the brain and then redistributed to the muscle which decreases the plasma concentration
85
Time line after MI
0-4 hours: no visible change 4-12: wavy fibers with narrow elingated myocytes 12-24: myocytehyperesinophilia 1-3 days: coag necrosis, neutrophilic infiltrate 3-7 days: disintegration of dead neutrophils and myofibers, macrophage infiltration 7-10: formation of granulation tissue and phagocytoss of dead cells 10-14: granulation tissue with neovasc 2w-2m: scar formation
86
Top 3 cancers affecting women in order?

Breast> Lung (highest mortality) > colon (lowest mortality)
87
Toxoplasma gondii
Protozoin | Treatment: pyrmethamine and sulfadiazine with leucovorin(folinic acid)
88
Treatment for defective class switching?
IVIg
89
trichrome staining
giardia
90
Types of collagen and where they are found
1- dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue 2- cartilage, vitreous humor and nucleus pulposus 3- skin lungs, intestines, bone marrow, blood vessels, lymphatics and granulation tissue 4- basement membranes
91
Ulcer with central black eschar surrounded by edema
Bacillus anthracis- chains of gram + rods live stock and bioterrosim MEdusa head colinies on standard medium produce an antiphagocytic d-glutamate capsule can live at 100C
92
Uncontrolled diabetes in pregnancy
``` Infant: Flaccid lower extremities absent ankle reflexes poorly developed lumbar spine and sacrum Cuadal regression ```
93
unique componiant of mycobacterial cell walls
mycolic acid==> a waxy long chain fatty acid that is covalently bround to sugars within the cell wall Nocardia and Mycobacterium
94
V wave on heart cath

Mitral regurge==> normal pressure should be 10mmHg during systole
95
vectorborne disease
mosquitos: malaria, dengue (brazil), chikunya Ticks: lyne disease, RMSF
96
ventricular pacemaker in third degree block
AV node
97
what are the symptoms and lab finding of legionllosis?

High fever, relative bradycardia, confusion, headache, GI symptoms like wattery diarrhea, hyponaturemia, elevated transaminases. This is kind of an opportunistic infection Sputum gram stain with many neutrifils with no organisms Treatment: floroguinolones or newer macrolids found in contaminated water
98
What are the symptoms of adenomyosis?
A: Heavy menstral bleeding due to increased endometral surface, uniformily enlarged uterus
99
What is Adenomyosis?

A Endometrial glandular tissue within the myometrium
100
What is the metyrapone stimulation test used for and what does it do?
Blocks 11-beta-hydroxylase and there for stimulates the secretion of ACTH. It is used to test the integraty of the HT-P-A axis.
101
What nerves pass through the jugular foramen?
CN IX, X, XI, Jugular vein
102
Which nerve is responsiable for syncope when tieing a tight tie?
Glossylpharengyl nerve when is located in the carotid sinus.
103
Hep B antigen on histology
finely granular homogeneous dull eosinophilic inclusions
104
Atresias of the jejunum/ilium
vascular injury in utero gastroschisis
105
raggid red fibers on gomori trichrome
mitochondrial diseases myoclonic epilipsy with raggid red fibers
106
pipercillin-tazobactam
Gram +, gram -, and anaerobic
107
prpp synthase
needed for purine and pyrimidine recycling if not active the patient get gout
108
length constant in demylination
decreases how far along an axon an electrical impulse can propagate
109
5th intercostal space
the lung is in front of the heart @ the midclavicular line
110
the spermatic cord passes through what
Deep inguinal ring==> transversalis facia==> superficial inguinal ring (external oblique muscle aponeurosis)
111
Selective immunoglobin deficency
failure of B-cells to switch from IgM to IgA when transfused with blood can have anaphalactic reactions to small amout of IgA in transfused blood commonly have otitis media
112
Cytokines
IL-1(Hot) = fever, recruit WBC IL-2 (T)- secreted by T-cells, stimulated T cells IL3(Bone)- growth of bone marrow stem cells S T IL4 (E)- stimulates switch to IgE secreted by Th2 cells IL5 (A)- bromotes differentiation of B-cells and class switching to IgA IL6(k)- acute phase reactants like CRP
113
azithoprine
6MP metabolite Broken down by xanthine oxidase and thiopurine methyltransferase toxicity caused by allopurinol
114
Clozapine
atypical antipsychotic AR: agranulocytosis, seziures, myocarditis, metabolic syndrome
115
tetrahydrobioten
BH4 | Cofactor in the synthasis of seritonin, melanin, and catacholamines via phenylalanine and tryptophan
116
valproate in pregnancy
Neuraltube defects
117
surfactant
made by type 2 pneumocytes decreases surface tension so that the smaller alvioli do not collapse because of high surface tension
118
right sided (complete) pure hemisensory loss
Thalamic stroke VPL most likely
119
reactions catalized by 21 hydroxylase
progesterone to 11-deoxycorticosterone 17-OH progesterone to 11 deoxycortisol
120
A-fib drug with new heart block, hypotension, severe constapation
CCB (nondihydropyridine) negative ionotropic effect slow conduction velosity at AV node
121
mediator of gram - septic shoch
Lipid A in the Lipopolysaccharide capsule of gram - bacteria like e-coli
122
agar for diphtheriae
cyctine-tellurite agar (dark black or loffelers medium
123
Polyol pathway
Glucose (aldose reductase) ==> sorbitol (sorbitol dehydroginase) ==> fructose
124
cause of diabetic retanopothy
sorbitol imbalance
125
what signifies irreversiable damage on histology after an MI
mitochondrial vacuolization and phospholipid containing amorphous densities
126
target of rabies
Acetylcholine receptors
127
MOA of tetrodotoxin
comes from puffer fish | binds to Na+ channels inhibiting Na+ influx and preventing action potential conduction
128
What degenerates in Wilson's disease
Putamen
129
when to use MAOI like phenelzine tranylcypromine
In atypical depression with mood reactivity, rejection sensitivity, and increased sleep and apitite
130
what accumulates in alzheimers
neuronal amyloid precurser protein
131
Infections that cause reactive arthritis
chlamydia trach., salmonella, shigella, yersinia, campylobacter, clostridium difficile Can also get conjunctivitis HLA B27
132
Lecithin-sphingomyelin ratio is a marker for fetal lung maturity what hormones control this
glucocorticoids (cortisol), prolactin, insulin, estrogens, andorgens, (t3-T4), catacolamines cortisol has the greatest effect
133
symptoms of iron deficecy anemia
Spoon nails, fatigability, pallor, esophageal webs (plummer-vinson syndrome) which causes dysphagia
134
alanine transfers its amino group to ______ before becoming glucose
alpha-ketogluterate
135
Trendelenburg sign
Hip drop when the ipsalateral foot is off the ground Damage to the contralateral superior gluteal nerve that arises from the L4-S1 ventral rami Weakened contralateral gluetus medius Injection to the superior medial part of the buttox
136
Nerve damaged in compartments syndrome involving the anterior compartment of the lag
Deep peroneal nerve
137
principle site of uric acid accumulation in the kidneys during tumor lysis syndrome
collecting ducts due to low pH (uric acid pKa=5.4)
138
For tumor lysis syndrome what also must be given to prevent kidney damage
allopurinol or colchasine
139
what precipitates hepatic encephalopathy in the setting of a GI bleed
Increased load of nitrogenous substances absorbed by the gut because there is blood being digested
140
Infections in burn patients
Gram + => staph or encerococcus Gram - ==> pseudomonas, klesella, acinetobacter Gram - on gram stain is pink
141
schizophreniform disorder
>1 month
142
schizophrenia
at least 6 months of symptoms
143
schizoaffective disorder
concurrent mood episode, active phase symptoms or schizophrenia + at lease 2 week lifetime history for delusions or hallucinations in absence of prominant mood symptoms
144
t(15:17)
AML With auer rods APML with abnormal promylocytes with auerrods on the smear
145
t(8:14)
burkett lymphoma
146
t(9:22)
CML BCR-ABL mutation
147
t(11:14)
Mantel cell lymphoma
148
Acute angle glaucoma
Treat with acetozolomide | Acts at the proximal convoluted tubule
149
HPV
Koilocyte on smear immature squamous cell with dense irregularly staining cytoplasm enlarged pyknotic nucleus rasinoid appearance Scant clear discharge Skin warts: 1-4 Genital warts: 6,11 Cervical, vaginal, vilvar anal neoplasia: 16, 18
150
when is B-hCG detectable in the serum
8 days 14 days for pregnancy test at home
151
Northern blot
mRNA
152
Beta 2 on uterus
Relax uterus | Defer premature labor
153
Left shift for oxygen-hemoglobin dissociation curve
1. Increased pH 2. Decreased 2,3 BPG 3. Decreased Temp (hypothermia)
154
Which amino acid is essential in patients with PKU
Tyrosine because there is no phenylalanine hydroxilase to convert phenylalanine to tyrosine
155
membranous nephropathy
IgG4 and PLA2R antibodies
156
Contralateral hemianopia with macular sparing
PCA territory infarction
157
Kerley B lines
short horizontal lines situated perpendicular to the pleural surface that represent eedema of the inerlobar septa seen in pulmonary edema
158
Cheyne-stokes breathing
congestive heart failure Granually increasing and decreasing tidal volumes until the next apnic period. PCO2 drops below a threshold and then the pt goes apnic Then when it goes above a certain level they breath really fast
159
Invasive aspergillus
In immunosupressed patients that have hyphe at acute angles and septe treatment for leukemia is a strong risk factor for fungal sinusitus
160
MOA for nitroglycerin
Actavates guanalate cyclase and promotes the conversion of GTP to cGMP==> increased cGMP lead to decrease Ca2+ resulting in decreased activity of myosin light chain kinase and finally dephosphorolation of myosin
161
Daptomycin
MOA: depolarized cellular membran by creating transmembrane channels AR: myopathy & CPK elevation note: inactivated by pulmonary surfactant so it cannot be used for PNA
162
different SpO2 between RA and RV
VSD | Holosystolic murmur at left sternal boarder
163
embryologic cause of tetrology of fallot
Deviation of the interventricular septum
164
Pyruvate kinase
PEP to pyruvate needed to make lactose in RBC results in helolysis and increased work for the spleen
165
NF-1
Chromosome 17 | NF-1 gene
166
oseltamivir
prevents virion release neuroamidase inhibitor Effective in Influenza A & B
167
Main amino acid in collagen
Glycine | GLY-X-Y many of the other amino acids are proline which makes kinks
168
Mycophenolate and tacrolimus
immunosuppressant drugs used post transplantation Hypercellular glomeruli
169
filtration fraction
FF=GFR/RPF
170
Lowest osmolarity in nephron
DCT Around 100 Highest in Loop of henley
171
Lymph from the testies
Para-aortic lymph nodes
172
Superficial inguinal lymph nodes
cutanious lymph from the umbilicus down including external genitetelia
173
Small blueish greyish specks on the buccal mucosa with high fever and nasal discharge lack of vaccinations
Koplik spots caused by the measals virus CCCK: Cough, coryza, conjunctivitis, koplik spots
174
Role of eosinophils in paracytic defense
Antibody-dependent cell-mediated cytotoxicity Type 1 hyper-sensitivity
175
fungus found in soil, bird feces, and bat feces
Histoplasma capsulatum dimorphic fungus immune response closely resembles TB (hilar lymphadenopathy) Specimins show ovoid cells with macrophages
176
Serotoli cells
Secrete inhibin in response to FSH
177
New odynophagia in the setting of GERD
Ulceration
178
Fractionated Heprin target
Xa
179
In the sarcomere Actin connects to: Myosin connects to:
Actin: Z line Myosin: M line
180
HLA-B*57:01
Abacavir hypersensativity Nucleoside reverse transcriptase inhibitor
181
ventricular contraction rate in patient with A-fib
AV node refractory period 90-170 BPM
182
change of bruise from blue to green
Heme oxygenase Decreaseds heme to biliverdin, CO, and ferric iron Biliverdin is green
183
PI3K/Akt(protein kinase B) /mTOR pathway
growth factor pathway Causes translocation to the nucleus and gene transcription Over active in many cancers
184
Isotretinoin
Accutane All trans retanoic acid analog Get a pregnancy test
185
Urea cycle
Add picture
186
effect of ureteral constriction or obstruction on GFR and Filtration fraction
decreases both FF increases transiantly but decreases because of effarent arterole constriction due to decreased GFR
187
presentation of patient with somatostatinoma
Hyperglycemia, cholelithisis, statorrhea
188
in what setting does dystrophic calcification occur
Cellular necrosis in the setting of normal calcium levels
189
predisposition for pylonephritis
Vesicoureteral reflux **most likely cause
190
Oval round yeasts within macrophages
Histoplasma capsulatum survive in macrophages Hilar lymphadenopathy, oral ulcers, hepatosplenomegaly
191
Serpentine formation
Virulance factor for TB Foul smelling sputum
192
Clindamycin
Binds to the 50S ribosomal subunit Pneumonia for alcoholics Acts against aerobic gram + and anaerobic organisms
193
Rifampin
Inhibition of DNA-dependent RNA polymerase SE: GI side effects, red-orange body fluid, cytopenia
194
Cholecyctectomy absorb most of their diatery fats where?
Jejunem
195
unilateral fetal hydronephrosis
obstruction at uteropelvic junction Last segment of the fetal ureter to calalize metanephros produces urine 8-10 weeks into pregnancy
196
first area damaged during global ischemia
hippocampus pyramidal cells of the hippocampus and neocortex and the perkinje cells of the cerebellum
197
Rash with strep throat
Scarlet fever | Caused by Group A strep
198
primary polydipsia
Hyponatriemia (would be hypernatremia in central or nephrogenic DI with a low serum osmolality Treat with water restriction
199
Symptoms of HSV-1 in children
Fever, visiculoulcerative gingivostomatitis (very painful leasions in the mounth and swollen gums) and cervical lymphadenopathy DS DNA virus Tzanck preperation Multinucleiated giant cells with intracellular inclusions
200
Buspiron
partial antagonist of the 5HTA receptor Slow onset Does not work for acute anxiety
201
when is GTP made in the TCA cycle
When Succinyl-coA is converted to Succinate used as a cofactor for phosphoenolpyruvate decarboxykinase
202
Brachieocephalic veins feed into what? how many are there?
There are two so blocking of just one can cause unillateral back up The feed into the SVC
203
Sudden withdrawel of gluccocorticoids
decreased CRH Decreased ACTH Decreased Cortisol
204
sudden upward jerking of the arm at the shoulder can cause injury to what?
Lower trunk of the brachial plexus Fibers of C8 and T1 Total claw hand deformity paralysis of intrensic hand muscles
205
Narcolepsy
-lapses into sleep or naps (3x per week for 3 months) Cataplexy: brief loss of muscle tone precipitate by strong emotion -low levels of hypocretin -1 in CSF
206
hormone that prevents lactation during pregnancy
Progesterone made by the placenta
207
histology of acute hepatitis
Spotty necrosis with balooning degeneration, counsilmen bodies and mononuclear cell infiltrates
208
presentation of viral hepatits
fever, malase, annorexia signs of cholestasis: jaundice, pruitis, dark-colored urine, and acholic stool
209
most common ligament involved in ankle sprains
anterior talofibular ligament
210
failure to metabolise ceramide trihexoside
Fabray Deficent in a-glactosidase A XR Angiokeratomas, cv, peripheral neuropathy, and kidney failure
211
Gram + rod with a very narrow zone of beta-hemolysis on blood agar
Listeria monocytogenes Tumbling motility at 22C Intracellular Listereolisin-O- pore forming toxin that kills phagosomes neonates prone to meningitis because there cell mediated immunity is not yet matures.
212
part of lung effected in chronic rejection after transplant
Small airways becaome inflammed with renal transplants it is vascular obliteration
213
hypertrophy of which cells with renal artery stenosis
Modified smooth muscle cells of the afferant arterial JG cells The sense sodium and electrolite content
214
target of cephlosporins
Transpeptidases
215
glanzmann thrombasthenia
AR Deficent or defective GP IIb/IIIa which normally binds fibrinagen There is no platelet clumping
216
target of Abciximab
GP IIb/IIIa
217
target of clopidigril
P2Y12 on platelet ADP receptors
218
inharitance pattern of G6PD
X-linked recessive
219
hepatitis B infection in infants
Usually contracted during birth If HBeAg posative then there is a High risk (90%) of chronic infection High viral replication rate mild elevation of LFT
220
What secretes intrensic factor
Paritial cells | They are in the upper glandular layer of the stomach
221
IL-12
Stimulate differentiation into Th1 cells this means no IFN-gamma is made to activate macrophages which are necessary to mediate intracellular organisms like mycobacteria
222
enzyme needed for F6P to ribose
Transketolase **G6PD is necessary for making NADPH
223
High potency first generation antipsychotics
Trifluoperazine Fluphenazine Haloperidol EPS side effects Parkensoniansim Dystonic (Try to Fly High)
224
Low potenticy first generation antipsychotics
Chlorpromazine Thioridazine SE: anticholenergic, antihistimine, sediation, alpha 1 blocade
225
Nerve responsiable for planter flexion and sensory innervation of plantar portion of foot
Posterior tibial nerve
226
Serum PTH, Ca2+, and phos in primary osteoperosis
Normal
227
treatment for hereditary orotic aciduria
Uridine supplimentation to bypass the enzymatic defect ( a defect in uridine 5'- monophosphate synthase no hyperammoniemia Autosomal recessive
228
gram + cocci in chains that cause UTI after procedure
Enterococcus Gamma hemolysis on blood agar (no hemolysis) PYR posative grow in bile and 6.5 sodium chloride
229
Target of c-diff toxins
Rho-regulatory proteins involved in maintaining cytoskeletal structure Disruption of cellular tight junctions
230
erythema infectosum
malase, coryza, headache and fever followed by a rash on the cheeks that feels burning hot Cause by parvo-virus 19 non- enveloped SS DNA virus Replicates in erythrocyte precursers in the bone marrow because of the presence of P-antigen Transmitted respiratory, food, and transplacentally This is also known as fifth disease
231
capitation
an arrangment in which a payor pays a fixed predetermined fee to cover all of the medical services required by a patient payment structure underlying the health maintance organization
232
Role of ATP in skeletal and cardiac muscle contraction
release the myosin head from its actin binding site and then energize a conformational change that resets the myosin head to contract again the next time it binds to actin
233
Carbamazepine
Epilepsy drug used for trigeminal neuralgia (irriataion of the trigeminal nerve) increases Na+ inactivation also a mood stablizer SE: Diplopia, ataxia, agranulocytosis, SIADH, Stevens-johnson syndrome Cytochrome P-450 inducer
234
Vaginal bleeding, uterine preg with no fetal heart beat Evacuated uterine contents containing felat tissue, edemitoud villi with focal trophoblastic proliferation, and some normal appearing villi
Partial hydactoform mole overexpression of paternal genes
235
Treatment for cyanide toxicity
Sodium thiosulfate Provides sulfer for rhodanses to metabolize the cyanide and excrete it in the urine also used: Sodium thiosulfate and hydroxocobalamin Note: Cyanide poisening presents with bright red venous blood
236
Lambert-eaton syndrome
Paraneoplastic syndrome with autoantibodies against pre-synaptic calcium channels movement improved with multiple stimulations
237
Pathogenisis of spider angiomata
Hyperestrogenism
238
cause of wrinkles
decreased collagen fibril production
239
Substances involved in andiogenisis
Vascular endothelial growth factor (VEGF) ==> IL-1 and IFN-gamma can activate this pathway Fibroblast growth factor
240
Leukotriene B4
stimulated neutrophil migration to sites of inflammation Other chemotactic agents: 5-HETE (leukotriene precursor), compliment component C5a, IL-8
241
t(14:18)
Follicular cell lymphoma Bcl-2 (c 18) onto Ig heavy chain locus( c 14)
242
Ostercytes are connected by what
gap junctions | They negotiate bone stress
243
acting out
expressing unacceptable feelings through actions
244
Denial
behaving as if an aspect of reality does not exist
245
displacement
transferring feelings to a more acceptible object
246
intellectualization
using intillect to avoid uncomfortable feelings
247
projection
attributing ones own feelings to others
248
reaction formation
responding in a manner opposite to one's actual feelings
249
splitting
seeing others as all bad or all good
250
ataxia-telangiectasia
``` AR Cerebellar atrophy leads to ataxia Repeated sinopulmonary infections ataxia in the first years of life Ineffeciant DNA repair ```
251
Embryologic origen of thyroid parafollicular cells
neural crest
252
main side effects of TZD
fluid retention due to increased sodium retention can cause decompensation of underlying congestive heart failure Target: PPAR-gamma and RXR **They have a very low risk of causing hypoglycemia because they increase insulin sensitivity instead of insulin secretion
253
MOA of colchicine
Binds to tubulin and inhibits polymerization into microtubules SE: Diarrhea and nausia
254
transketolase
present in the cytosol and utilized in the pentose phosphate pathway Uses thymine as a cofactor
255
Activation of which pancriatic enzyme can cause acute pancreatitis
Tripsinogen to tripsen because that activated all of the other pancreatic enzymes
256
Membranous nephropathy, flank pain, hematuria, right sided varicocele
renal vein thrombosis due to loss of anti thrombin III
257
kind of incontanance in MS
urge incontanance | Overactivity of detruser due to a leasion that basically overrides the brains control of micturation
258
Babesiosis
tick born infection Splenectomy puts patients at an increased risk ``` Cross shaped intraerythrocytytic inclusions Thrombocytopenia hemolytic anemia respiratory distress found in conneticut ARDS, flu like symptoms ``` Icodes tick vector
259
Cause of valley fever
Coccidioides immitis Spheruoles packed with endospores
260
Niacin side effects
``` Gouty arthritis flare flushing warmth hepatotoxicity hyperglycemia for patients with diabetes ```
261
Alendronate and risedronate
bisphosphonates structurally similar to pyrophosphate and attach to hydroxyapatite binding sites in areas of increased bone turnover can have stable or increased done density
262
Agent used to short term treatment of insomnia
Zolpidem structurally similar to benzos 1. not as addictive 2. no anticonvolsant activity 3. no muscle relaxing properties
263
mechinism of action of opiaits for pain control
increases K+ efflux out of cells causeing hyperpolerization of those cells controlled by G-protein linked receptors **Think of GIRK
264
Fever, throat pain, dysphagia, ispiratory strider immature hematopoietic stem cells on peripheral blood smear
T-ALL Dysphagia and strider are indicitive of a medistinal mass B-ALL would have hepatosplenomegaly and bone pain common in young boys
265
acute rejection
1 week after transplant host T cells sensitized to graft MHC Mononucular infiltrates
266
Treatment for patient with hemofelia acutely
Thrombin because it bypasses the deficency in the intrensic pathway (VIII or IX)
267
Heteroplasmy
having different organillular genomes (mitochondria) ***explenation of different phenotypes
268
comedocarcinoma
Ductal carcinoma in situ has not invaded the basement membrane Central necrosis with ducts Micro calcification clusters
269
what cannot use ketone bodies for fuel
Erythrocytes
270
what does ADH injection do to the clearance of urea
it decreases it because it activates urea transporers in the medullary collecting duct
271
Nesiritide
Recombinant form of BNP
272
loss of sensation of lateral forearm | weakness lifting at elbow
C5-c7 | musculocutanious nerve
273
Premature infant with high pitched cry, prominant scalp veins, tense fontenels, blood in lateral ventrical on ultrasound
Germinal matrix hemorrhage highly vascularized subventricular layers
274
liver and lung dysfunction with acid-Shiff reaction and intracellular glanules
A1AT deficiency intracellylar granules have unsecreted A1AT
275
which receptors on beta cells decrease insulin secretion in the presence of epinepheran
Alpha 2 Somatostatin 2 so it these are blocked then insulin will increase when epi is administered
276
pink colored mucoid colonies on MacConky agar
klebsiella pneumonae
277
enzyme deficient in fructose intolerance
aldolase B presents when the baby switches from breast milk to formula hereditary fructose intolerance is AR aldolase B is also needed for gluconeogenisis so the patient becomes hypoglycemic during times of fasting
278
Ethambutol
TB drug MOA: inhibition of arabinosyl SE: optic neuropathy causing central scomata
279
4 drug combo for TB
Rifampin: inhibition of bacterial DNA dependant RNA polymerase ISN: inhibition of mycolic acid synthasis (give vit B6) Pyrazinamide Ethambutol: inhibition of arabinosyl
280
Treatment for allergic asthma
Leukotriene D4 ANTAGonist because they can cause mucus hyper secretion and edema Drugs: zafirlukast and montelukast
281
Increased MMP and actin containing fibroblasts at the site of w would
contracture
282
order of conduction velocity in the heart
fastest==> slowest Perkenje system (ensures bottom up contraction of the ventricles) ==> atrial muscle==> ventricular muscle==> AV node (slowest to allow the ventricals to fully fill with blood during diastole) Pneumonic==> Park At Venture Ave
283
what is elevated in anaphylaxis
You measure tryptaase to support your diagnosis anaphylaxis is a result of wide spread mast cell and basophil degranulation leading to an increase in inflammatory mediators, histamine, and tryptase
284
what leads to basophil and eosinaphil degranulation
receptor cross linking and aggrigation of IgE on the surface of these cells
285
Argatraban
direct thrombin inhibitor Use for the treatment of HIT
286
increased ornithine acid excretion and high ammonia levels
ornithine decarboxylase deficency
287
fusobacterium and peptostreptococcus on culture of a lung leason
Indicative of a pulmonary abcess caused by these anarobes Treatment: clindamysin Think aspiration as a cause (ie. seziure disorder)
288
An oocyte from the fallopian tube soon after ovulation would be in what stage of gametogenisis
Metaphase of meiosis II
289
homonymous hemianopia
both eyes cant see the right or left visual field optic tract leasion
290
lipid stain after a cerebral infarct
microglea have lipid dense cytoplasms at thi spoint because they are the macrophages of the brain and they are taking up a lot of mylen that was damaged they infiltrate about 5 days after an infarct neurons show irreversiable damage macroscopic damage can be seen after 12 hours and hypodense areas can be seen after 1 week
291
desired quality of drug for hepatic excretion
high volume of distribution high lipid solubility
292
Panic disorder
recurrent, unexpected panic attacks (can't feel them coming on) ``` PANICS Palpitations Paresthesias Abd distress Intense fear of losing confrom for i month or more Chest pain/chills shaking ```
293
social anxiety
anxiety restricted to social situations
294
generalized anexity disorder
chronic multiple worries, anxiety, tension
295
recombination
exchange of genes between 2 chromosomes by crossing over within regions of dignificant base sequance homology
296
rituximab
used in non-hodgkin lymphoma Targets CD-20
297
Retroperitoneal abdominal organs
``` Suprarenal glands Aorta & IVC Duodenum (except first part) Pancreas (head and body) Ureters & bladder Colon Kidneys Esophagus Rectum ```
298
kidney-bean shaped diplococci
meningococcal menigitis Toxin: lipooligosaccharide activates TNF-alpha, IL-1B , IL-6, IL-8 Waterhouse fredrechson syndrome with bilateral adrenal hemmorhages
299
Patients with one or more lifetime manic episodes
Bipolar I disorder
300
Hypomania with major depressive episodes
Bipolar II
301
flutamide
competitive testosterone receptor inhibitor use for bone pain in prostate metastasis
302
BPH drugs that decrease the size of the prostate
5- alpha reductase inhibitors eg. finasteride, duasteride
303
alpha adrenergic antagonists for BPH
terazosin, tamsulosin
304
non casiating grnulomas on colonic biopsy
CHRONE'S DISEASE Transmural inflammation skip leasions
305
histologic changes in prion desease
spongiform transformation of grey matter
306
c-jun | c-fas
DNA binding proteins that can be detected with the use of a south western blot
307
dip after alveolar oxygenation
mixing with deoxygenated blood from small cardiac veins
308
hurshprung disease
failure of neural crest cells to migrate to the rectum
309
type I muscle fibers
Pastural support High myoglobin, low glycogen, high amount of mitochondria Ex. paraspinal muscles
310
vaccienes composed of a polysaccheride attached to a protein capsule
strep pneumo Neisseria meningitidis H. Influenza
311
potentcy
dose of drug that is required for the desired effect the lower the E(50) the more potant the drug
312
mucicarmine stain
cryptococcus neoformans red stained round yeast cells
313
Renal plasma flow calculation
PAH clearance=(urine [PAH]xurine flow rate)/plasma PAH RBF=PAH clearance / (1-hematocrit)
314
Blood supply of AV node in a patient with L dominant circulation
Left circumflex artery
315
Ivabradine
blocks funny sodiu channels during phase 4. Only slows HR without effceting contractility
316
risk with interscalene nerve blocks
ipsalateral diaphragmatic paralysis C3-5 keep the diaphragm alive used to paralize the brachial plexus
317
causes of vit A deficency
Insufficient dietary intake pancreatic insuffancy cholestatic liver disease/liver obstruction==> generalized puritis and vit a deficency intestinal malabsorption
318
erythema marginatum
circular leasions with central clearing on the abdomen seen in rheumatic fever
319
persistant fever, brassy cough, difficulty breathing, stridor
Croup caused by paramyxovirus can also see the steaple sign on X-ray `
320
is the ID50 for shigella high or low
low | you need as little as 10 organisms to be infected
321
Arsenic poisoning treatment
Dimercaprol increases urinary excretion of heavy meatles by forming stable, non-toxic soluable chelates
322
Symptoms of arsnic poisening
GARLIC BREATH vomiting/watery diarrhea, QT prolongation Chronic: stocking glove neuropathy it impares cellular respiration viz inhibition of pyruvate dehydroginase
323
increased propionic acid in the blood
issues with metabolism of valiene, isoleucine, methionine, cholesterol, or odd chain fatty acids due to a deficency of propinoyl CoA carboxylase
324
stab wound just above the clavical
damages the lung pleura causing a tension pneumo
325
NNT
NNT=1/ARR
326
ARR
control rate - treatment rate
327
RR
treatment rate / control rate
328
RRR (relative risk reduction)
ARR/control rate
329
Acyclovir
anti-viral | nucleotide analog that is incorederated into newly replicating viral DNA
330
Chocolate agar
H. Influenzae
331
Thayer-martin agar
N. Gonorrhoeae | N. Meningitidis
332
Bordet-gengou agar
B. pertussis
333
Tellurite agar
C. diptheriae
334
Lowenstein-Jensen agar
M. Tuberculosis
335
Eaton agor
M. pneumonae
336
MacConky agar
Lactose fermenting enterics Fermenting colonies turn pink
337
eosin-methylene blue agar
e coli
338
sabouraud agar
fungi
339
vein that supplies the fundus of the stomach
short gastric veins that drain into the splenic vein
340
Neuroenducrine markers
NCAM, enolase, chromogranin, synaptophysin
341
IP3 activates
protein kinase C after activated by PLC
342
layers that you have to go through to do a cricothyrotomy
1. skin 2. superficial cervcal facia 3. investing and pretrachial layers of the deep cervical facia 4. Cricothyroid membrane
343
cocaine withdrawl symptoms
Increased appetite, hypersomnia, intense psychomotor retardation, severe depression
344
NK-1 receptor antagonists
aprepitant, fosaprepitant used for chemo induced emisis
345
area posteremia
chemoreceptor trigger zone that communicates with nucleus tractus solitarus
346
how does digoxin slow the ventricular rate during a-fib RVR
enhancing vagal tone which leads to decreased AV nodal conduction
347
early sign of doxyrubacin accociated cardiomyopathy
swelling of the sarcoplasmic reticulem
348
common peronial nerve damage
unable to every foot, numbness over orsum of foot and lateral shin most commonly damaged nerve
349
holosystolic murmur over left sternal boarder that increases with hand grip exersice
VSD hand grip exercise increases after load
350
cell type that predominates in sarcoidosis
CD4+ T-cells
351
mutation in familial hypocalciuric hypercalcemia
Calcium sensing receptors with are transmembrane g-protein coupled receptors that help to moniter PTH release AD
352
entacapone
COMT used in parkensons that inhibits peripheral degradation of levadopa thereby increasing the quantity of levadopa entering the brain
353
lymph drainage from the scrotum
superficial inguinal nodes Swollen with a superficial scrotal abcess **Pay attention to the word superficial
354
difference between mono and mono-like syndrome
Infectious mono is caused by EBV and have serum heterophile antibodies that agglutinate with horse serum with out the agglutination it is most likely CMV
355
treatment of infertility in women with PCOS
Estrogen receptor modulation with clomiphene
356
antiseptic properties of alcohols (isopropanol and ethanol)
disruption of cell membranes denaturation of proteins
357
chlorhexidine
disruption of cell membranes coagulation of cytoplasm
358
iodine
halogenation of proteins and nucleic scids
359
gp 120 in hiv
attachemt to target cell by binding CD4 receptor cleaved from gp160 which is glycosolated before hand
360
pharmocologic intervention for restless leg syndrome
dopamine agonists
361
transient side effects of ACE-I
Hyperkalemia and increased creatnine
362
hypoketoic hypoglycemia
defect in beta fally acid oxidation nost commonly an acyl- CoA dehydroginase deficency
363
mood reactivity, unstable relationships, chronic feelings of emtiness, inappropriate intense angre, stress related paranoia
borderline personality disorder
364
perineal body
tendinous center point of the perineum that seperates urogenital and anal triangles cut in an appeasiotomy
365
compisition of MHC-1
heavy chain and B2- micorhlobulin
366
MHC 2 compisition
Alpha and beta polypeptide chain
367
what is the potentancy of an inhailed analgesic determined by?
minimal alveolar concentration percentage of anesthetic in inspired gas that renders 50% of patients unresponsive to painful stimuli
368
how does the PSNS slow the heart rate
prolonging the AV node refractory period
369
Where is the leasion is decerebrate posturing
at the level of the pons
370
damage to the cerebral hemispheres
decorticate (flexor) posturing
371
causes of polyhydramniose
GI obstruction, anencephaly
372
rhinovirus
SS + sense RNA that is naked Does not require additional machienery to replicate
373
edema factor in B. anthracis is similar to a toxin from??
B pertussis both increase cAMP
374
signs and symptoms of vit-A over use
alopecia, dry skin, HLD, hepatospleno megaly, and pseudotumorcerebrae which can present with papilledema
375
sickle cell inheratance
AR
376
next test to order after Alk phos is elevated
gamma-glutamyl transpeptidase (GGTP) tells you in the problem is in the liver or the bone
377
what is increased in hereditary spherocytosis
mean corpuscular hemoglobin concentration
378
what do integrins bind to
fibronectins fibronectins are large glycoproteins produced by fibroblasts and some epithelial cells binds to integrins, matrix collagen, and glycosaminoglycans
379
treatment for diptheria
1. diptheria antitoxin (passive immunization) 2. penicillin or erythromycin 3. DPT vacciene
380
ehlers-danlos syndrome possible cause and presentation
easy bruising, thin skin pro-collagen peptidase deficency ==> unable to cleave the N-terminal peptide issue with extracellular protein cleavage characterized by disulfigde rich globular domanes
381
esophagus on CT
collapsed tube located between the trachea and the vertebral bodies on the L side
382
H. influenza
requires hematin and Nad+ to grow on blood agar depends on a polysaccharide capsule undervaccinated child recent ototis media
383
POM-C
ACTH MSH Beta-endorphan (binds to mu and delta receptors)
384
treatment for PDH deficency
ketogenic diet leucine and lysine and exclusively ketogenic and will not aggravate lactic acidosis
385
AA that are ketogenic and glucogenic
phenylalanine, isoleucine, tryptophan
386
non-painful original genital ulcers progresses to several draining ulcers with lymphadenopathy with cytoplasmic inclusion bodies
lymphogranuloma venereum caused by chlamydia trachomatis serotype L1 - L3
387
hydrocephalus, intracranial calcifications, and chorioretitinitis (white-yellow)
triad on intra-uterine infection of toxoplasmosis (cat-box disease)
388
short acting insulins
lispro, aspart, glulisine altered c-terminal of b chain allows for more rapid absorption
389
labs when T3 is given
decrease TSH, T4, and rT3
390
flumazenia
used for benzodiazapine overdose
391
antidote for seritonin syndrome
cyproheptadine 5HT receptor agonist
392
donepezil
cholenesterase inhibiter used in alheimerz dementia 3 ways to treat: 1. inhanced cholinergic neurotransmission 2. neuroprotection via anti-ocidents like Vit-E 3. NMDA receptor antagonism
393
vincristine
used to treat non-hodgkin lymphoma interferes with microtubule formation in nerve axons causing numbness and tingling in the fingers
394
bilateral numbness in fingers 1-3 in a dialysis patient
deposition of Beta-2-microglobulin (dialysis related amyloidosis) in the carpal tunnel
395
enzymatic deficency in heriditary gentitaional diabetes
glucokinase this is a kind of maturity onset diabetes of the young mild, nonprogressive hyperglycemia that worsens with pregnancy induced insulin resistance
396
WNV
SS RNA + sense mosquito vector encephalitis
397
Dihydrobiopterin reductase
needed to make both Tyrosine from phenylalanine and DOPA from tyrosine elevated prolactin after restriction of phenylalanine
398
symptoms of the electrolyte abnormalities caused by hyperaldosteroneism
Hypokalemic alkalosis causes muscle weakness and paresthesias
399
intercranial hemmorhage in new born with CF
Vit K deficency
400
skeletal muscle resistance to verapimal
no dependance on extracellular calcuium
401
what accounts for the green color of sputum with an S. pneumo infection
myeloperoxidase from neutrophils
402
how long does it take for myocyted to lose contractility after ischemia
60 seconds ATP [] is still normal but it is used rapidly withing the cell and lactate builds up
403
gene mutation in neurophysins
carrier protein in the pituitary mutations could cause diabetes m
404
what provides the major proliferative stimuli for cellular componants of atherosclerotic plaques
platelets PDGF and TGF-beta
405
mechanism and use of sumatriptan and other triptans
5-HT-1B/5-HT-1D agonists Block post synaptic seritonin action seritonin is a vasoactive amine
406
cold agglutinans in the presence of a persistant cough and pulmonary infiltrate
mycoplasma pneumoniae responsiable for the transient anemia seen with this infection
407
Nicotinic cholenergic receptors
these are ion channels with 5 subunits with 2 Ach binding sites that will open if both binding sites are filled
408
what is aqueous humor produced by and what decreases its production
ciliary epithelial cells Timolol, betaxolol carbonic anhydrase inhibitors alpha agonists: brimonidine
409
where can a surgeon gain access to the great saphanous vein
medial leg or just inferolateral to the pubic tubricle
410
aortic arches
1st: portion of the maxillary artery 2nd: stapedial artery third: common and proximal internal carotid arteries fourth: true aortic arch and subclavian arteries fifth: obliterated sixth: pulmonary ateries and ductus arteriosus
411
pharengial arches
1- trigeminal nerve, mandible, malleus 2- facial nerve, muscles of facial expression and eare, hyoid associated muscles 3-glossopharengial- hyoid bone and stylopharengeas muscle 4- superior larengial branch of the vagus nerve muscles of pharynx and soft pallet 6- recurrant lyerengial branches of the vagus nerve, muscles of the larynx
412
retinal hemmorhages and a full fontenal
suspect shaken baby syndrome
413
zellwiger syndrome
peroxisomal disease with issues breaking down VLCFA hypotonia and seziures, hepatomegaly, mental retardation, early death refsum disease is a problem with alpha oxidation of VLCFA
414
Macular sparing
occipital leasion
415
catalase + organisms
``` staph A Burkholderia cepacia Serratia marcescens nocardia aspergillus ``` affect people with CGD
416
perfusion defect not matched by ventilation defect
PE caused by DVT
417
where do anal fissures usually occur
posterior midline distal to the dentate line tearing pain blood on tissue paper
418
factor V lyden
mutated factor V cannot bind protein C and thus causes a HYPERcaoguable state
419
pseudogout
calcium pyrophosphate deposition disease rhomboid shaped pyrophosphate crystals knee is often the first joint affected
420
sebacious glands
holocrine- cell lysis releases entire contents of the cytoplasm inflammatory acne
421
surface protein on bacteria
confers virulance to human cells
422
baclofen
agonist of the GABA-B receptor and used for muscle relaxation
423
haptaglobin
binds to free hemoglobin especially in the case of hemolytic anemia
424
what takes over in the case of fructokinase deficency
Hexokinase fructose ==> f6p
425
most common cause of retinitis in HIV patients
CMV HIV patients with CD4+ counts
426
cystic posterior neck mass (cystic hygroma), lymphedema, deminished pulses
turners syndrome
427
posatively skewed
Mean>median>mode oppisite for negative skew
428
what detects changes in CO2
carotid body and aortic chemo receptors stimulated by hypoxemia
429
What muscles need to be strengthened in women with stress urinary incontinance
levator ani to decrease urethral hypermobility
430
pertussus
gram - coccobacillus adheasions and toxins adenylate cyclase toxin and pertussis toxin 100 day cough
431
niacin
increases HDL, lowers LDL Flushing is mediated by prostaglandins can decrease these side effects with aspriin
432
renal stones in the setting of a pituitary tumer
sign of hypercalcemia caused by hyperparathyroid pancreas should also be screened
433
lactase deficency causes a decrease in....
stool pH
434
kind of mutation in sickle cell and hemaglobin C
Missense glutamate is replaced for valiene or leucine
435
nonnucelotide reverse transcriptase inhibitors
nevirapine and efavirenz life threatening hepatic failure is a side effect do not require activation via intracellular phosphorolation
436
what do you want to be sure to ligate when removing an ovary?
the suspensary ligament of the ovary which contains the ovarian artery, veins, lymphatics, and nerves
437
stop codons
UAA, UAG, UGA recognised by relasing factor 1
438
infant with oral thrush, interstitial PNA, and lymphopenia within the first year of life
suspect vertical transmission of HIV-1 especially if the mother is an IV drug user and did not take ART during her pregnancy
439
Polyarteritis nodosa
renal and viseral organs affected==> it spares the pulmonary arteries immune complex mediated transmural inflammation with fibranoid necrosis treat with corticosteroids and cyclophosphomide
440
physiostigmine
acetocholenesterase inhibitor that penetratates the CNS Neostigmine==> NO CNA penetration
441
how long do symptos need to be around for someone to be diagnosed with major depressive disorder
>2 weeks go thorugh SIGECAPS
442
stroke in the setting of DVT
Atrial septal defect split S2 that does not change with inspiration
443
loss of sensation associated with decreased petellar reflexes
Femoral nerve compression medial thigh and leg
444
caloric equivilants
protein==> 4 cal /g fat ==> 9 cal/g ethanol 7 cal/g
445
muscuranic + nicotinic blockade
botulism | symptoms improve with multiple stimulations
446
what medication can increase hypoglycemic unawareness in patients with diabetes
non-selective B-blockers like propanolol
447
enzyme effected in xeroderma pigmentosum
Endonuclease
448
most effective treatment for specific phobia
Behavioral therapy think of people being afraid of elevators
449
defective enzyme in maple syurpe urine disease
alpha ketogluterate thymine, lipolate, Co A, FAD, and NAD are cofactors some poeple will improve with thymine infusion
450
head ache and sudden blindness in an older woman
temporal arteritis which is a giant cell/ large vessel arteritis can present with polymalagia rheumatica (torso, shoulder, joint pain with fever and weight loss) can occur in men IL-6 is implicated so use tocilizumab to treat
451
hand joints involved in rheumatoid arthritis
MCP, PIP Spares the DIP joints which are effected by osteoarthritis prolonged morning stiffness >30min often accompanied by systemic symptoms like fever and weight loss
452
porcelin gallbladder
high risk of gall bladder cancer caused by chronic cholecystitis
453
bilateral angiomyolipomas
associated with tuberous sclerosis autosomal dominant they have brain hamartomas and ash-leaf skin patches, cardiac rhabdomyomas
454
side effects of methotrexate
it effects rapidly growing cells so you get mouth ulcers, hepatotoxicity, and pulmonary fibroses
455
what is contained in the hepatoduodneal ligament
portal vein, hepatic artery, common bile duct if that is occluded and the patient is still bleeding it is most likely the IVC
456
AV shunt affect on preload and after load
increase preload because they decrease resistance of flow They also decrease total periferal resistance
457
accuracy
gives a number close to the same value
458
persicion
consistantly provides the same result Reproducability of a test **Reliability is the same as persicion
459
rebound nasal congestion
stop the decongestant
460
patient with BPH that with orthostatic hypotension
terazosin or doxyzosin alpha-1 blockade **dont assume they are on other drugs
461
recurrant nisseria infections
inability to make the membrane attack complex with complement multiple episodes of menengitis and small vessel vasculitis (hands and feet)
462
drug of choice for beta blocker overdose
glucagonincreases camp and thus increases calcium in cardiac myocytes
463
what part of tRNA binds to amino acids
the 3' end the anti codon is on the opposite end and binds to mRNA
464
meglitinides
Repaglinide and nateglinide short acting glucose lowering medications similar to sufonureas and act by binding to the ATP dependant K+ channel in the pancreatic beta cell membrane
465
short term treatment for insomnia in an elderly patient
melatonin agonist like Ramelteon for elderly patients you need to pay attention to the side effects like dizzyness and confusion
466
what is seen on endometreal cutterage during an ectopic dregnancy
decidualized endometreum which you would see in someone iwth a normal pregnancy
467
what causes type 1 diabetes
leukocytic infiltration of islet cells because if is an autoimmune disease
468
lab findings in iron deficency anemia
low serum ferritin Low MCV High circulating transferrin remember that iron defecincy anemia is a MICROCYTIC anemia
469
imuune cell with which cell marker surrounds necrtizing granulomas in TB
CD14 (monocytes and macrophages)
470
Type II pompe disease
acid alpla glucosidase deficency - normal glucose levels - severe cardiomegaly - glycogen accumulation in lysosomes "pompe trashes the pump"
471
Von gierke
Glucose-6phosphatase deficency - severe fasting hypoglycemia - increase glycogen in liver - increased blood lactate - increased uric acid - hepatomegaly
472
cori disease
Debranching enzyme deficency Milder form of von-girk with normal lactate levels
473
mcardle disease
skeletal muscle glycogen phosphoralse deficency -increased glycogen that cannot get broken down so they have painful muscle cramps, myoglobinuria, and arrythmia from electrolyte abnormality
474
what step is effected in someone iwth GAPD deficency
from G6P ==> 6-phosphogluconate which makes one NADPH which is needed to combat oxidative stress part of the hexose monophosphate shunt X linked ressesive disorder
475
antibodies against PRP
immunity against H-influenza polyribitol ribose phosphate
476
people with alpha-1 anti tripsin deficency should avoid
smoking they are missing A1AT which impairs elastin degradation by neutriphil products, os they are most likely to get emphasemia at a young age
477
what should be used for post surgical urinary retention
a muscuranic agonist like Bethanechol also used for post surgical ilius
478
Most common lung cancer in non-smoking women with no occupational exposures
ademocarcinoma it is often a peripheral leasion
479
psyologic changes in lung mucosa in patients with CF
increased Na+ absorption causes mucus to be dehydrated the Na+ channel is usually inhibited by Cl- but sice the CFTR gene codes for the Cl- channel more Na+ is absorbed
480
how does prostate cancer metastisise
the prostatic venous plexus **note that the lymphatic system rarely aids in metastisis to the bone
481
actinomycosis
anaerobic gram + bacteria Treat with panicillin if it causes systemic disease look like big clumps of purple with sulfer granules patients with poor dentition because it is a part of the normal flora filimentous branching patterns
482
first line treatment for absent sezures and tonic clonic seziures
Valproate
483
penicillin is strcuturally similar to what
D-ala-D-ala
484
drug to use for pulmonary hypertension
Bosentan endothelin-receptor antagonist that blocks the vasoconstrictive effects od ando thilin
485
mechanism of OCPs in preventing pregnancy
they maintain low serum gonadotrophen levels while estrogen and progesterone remain high LH and FSH are supressed
486
what is the normal intrapleural pressure
-5 drops to - 7.5 upon inhilation
487
what physiologic process contributes to abcess formation
lysosomal content release by macrophages
488
true vocal folds are covered by
straified squamous epithelium
489
what is the primary component of pulmonary surfactant
phosphatidylglycerocholine | phosphatidylcholine ==> also known as lechtin
490
alternative medication to asprin in the setting of angina pectoris
clopidogrel
491
what bonds account for elastins elastic properties
interchain cross linking invilving lysine these are called desmosine cross links this happens because of a large pulse pressure
492
head bobbing and bounding femoral pulses
aortic regurge
493
decreased absorption of cystiene, ornithine, lysine, arginine (cola)
Cystinuria increased risk for kidney stones sodium cyanide nitroprusside test +
494
where is Ach decreased in Alzheimers
the nucleus basalis or the basal nucleus of meynert whitch participates in memory and cognition located at the base of the forebrain and projects to the neocortex the hippocampus is also involved in memory
495
what structure can be obstructed by the SMA
the transverse portion of the duodenum can happen in any condition where the patient has decreased mesentaric fat
496
ehlers danlos
can be caused by a procolligen peptidase deficency in which patients are naple to cleave the N-terminus of collagen
497
how do most envoloped viruses aquire their envolope
by budding off of the host cell plasma membraane HSV uses the nuclear membrane
498
treatment for and presentation of enterobiasis
perianal itching use albendazole first like pyrantel pamoate can be used in pregnant women
499
when e-coli is plated with lactose why are bothe B-galactosidase and galactoside ppermiase expressed/prodouced
there is one mRNA coding for both enzymes
500
notching of the ribs on x-ray
coarctation of the aorta
501
deficency in CGD
NADPH oxidase diagnosis made by DHR flow testing and NBT testing
502
what does disulferam inhibit
aldehyde dehydroginase
503
triad of mcCune albright syndrome
Mutation during embryogenisis of the GNAS gene ==> gain of function mutation in alpha subunit of G-proteins leading to multiple abnormalities Cafe-au-lait spots endocrine abnormalities (precousious puberity, hyperthyroid) Fibrous dysplasia- abnormal proliferation of fibroblast like cells
504
dermititis induced by poisen ivy (urishol)
delayed type hyper sensativity that is elicited by T-cells T-cells are associated with the associated damage
505
what must be known to amplify a DNA sequance of intrest
the DNA sequance of the segments flanking the segment of intrest
506
drooping of the shoulder problems reaching over head impaired winging of the scapula
Trapizius | Nerve T12
507
where is RNA made
in the nucleolus
508
glossopharengial nerve sensory innervation
tympanic membranee, eustation tube, posterior tound, general tonolar lining (gag affarent portion), carotid body, carotid sinus
509
polymyositis
proximal muscle weakness and myanagias with insidious onsey ANA and anti-jo (Histidyl tRNA synthetase) antibodies are likely present elevaled CK endomysieal monocytic infiltrate on histology interstitial lung disease and myocardidis are other complications can be a paraneoplastic manifestion of adenocarcinoma
510
HIV asociated dementia
Will see microglial nodules on histology progressive memory loss with CD4+ counts
511
mechanism of resistance to aminoglycosides
acetylation on the drug
512
oppositional defiant disorder
intentionally annoys others, blames others for own mistakes, easily annoyed differentiate from conduct disorder: harms others or animals
513
best immidiate treatment for patient that is hypoglycemic and unconsious
IM glucagon
514
HER2/neu oncogene
185 kD transmembrane protein that have tyrosine kinase activity and accelerated cell proliferation when activated
515
histology of AAA and cause of AAA
chronic transmural inflammation
516
Ankalosing spondolitis
-low back pain - limited chest expansion - enthesitis (inflammation of the site of insertion of a tendon to the bone -acute anterior uveitis
517
drugs that impair lithium excretion
HCTZ (mostly, ACEI , NSAIDS, decreased GFR lithium tox: nausea, vomiting, diarrhea, confusion, ataxia, tremmers, faciculations
518
final mutation to get to adenocarcinoma of the colon
APC==> K-RAS==> p53
519
what best explains metoprlol's effect on BP
decreased level of circulating renin they decrease renin release from the kidney
520
where are enhancers located on genes
Variable locations can be upstream, downstream, close, or far
521
a hyperpigmented leasion on or below the breast that becomes sore with menses and increases in size with puberty
Extra nipple caused by the failed involution of the mammory ridge
522
what is responsiable for the skin reaction to a bee sting
histamine
523
what does the superior thyroid artery course with
superior thyroid artery superiorthyroid vein external branch of the superior lyrengial nerve which iinnervated the crycothyroid
524
what activates tripsin
enteropeptidase
525
facial swelling after being extubated
think parotitis caused by staph aureus measure amylase
526
what does 99mmTc-pertechnetate detect
the presence of gastric mucosa in the case of a meckles diverticulum failure of obliteration of the omphalomesenteric duct
527
anti fungal that targets the cell wall
caspofungin blocks glucan synthasis
528
deficency in what vitamin causes complications with the measels virus
Vit A | can prevent ocular complication and decrease recovery time
529
common reperfusion arrythmia
accelerated idioventricular
530
mifepristone
progesterone antagonist
531
where do P-bodies interact with mRNA
cytoplasm only
532
what are women with prolactinomas at risk for
loss of bone mass because of decreased estrogen
533
what kind of genetic mutation in CF
frame shift
534
what does raltegravir do
impairs mRNA transcription it is an integrase inhibitor
535
what differentiates schizophrenia from schizo effective disorder
mania is not associated with schizophrenia but it is associated with schizo-effective disorder with schizo-affective disorder the patient must have hallucinations without a mood symptom but it can be associated with mania
536
ulcerated anal mass in the setting of HIV
squamous cell carcinoma of the anus caused by HPV can precent with itching and bleeding
537
fenoldopam
a dopamine (acts only at D1) agonist used for vasodilation and naturesis
538
side effects of atazanavir (protease inhibitor used in HIV
Lipodystrophy Hyperglycemia CYP 450 inhibitor
539
what is a PFO
incomplete fusion fo atrial septum primum and secundum
540
most important factor of e-coli that allows them to cause UTIs?
Fimbrial antigen
541
pattern of oxygen labs in chronic blood loss
PaO2==> normal SaO2==> normal total oxygen content==> decreased
542
what in packed RBCs can cause hypocalcemia
citrate this happens when there is a big trauma and you need to transfuse a lot of blood
543
patient that doesn't like to socialize for fear of critisism but is very respectful of others
avoident personality antisocical people have a disregaurd for other peoples emotions and often become involved in criminal activity
544
sheets of primitive cells with many mititic figures in the cerebellum of a child
medulloblastoma must use a microscope to differentiate from pilocyticastrocytoma
545
fibrous deposits around the tricuspid and pulmonary valves with pulmonary valve stenosis
think carcinoid syndrome measure a urinary 5-hyroxyindoleactic acid
546
order of airway resistance
Medium airways (because of turbulent flow) > trachea> bronchials>terminal bronchioles **don't forget about turbulant frow
547
why is primaquine added to chloroquine for maleria treatment
to completely erredicate malaria and prevent relapse of the virus
548
congenital cateracts, deafness, and pulmonary stenosis with PDA
congenital rubella which can be prevented with a live attenuated vacciene before conception
549
Percardidis symptoms 3-4 days after an MI
Inflammation of the pericardium overlying the necrotic segment of myocardium dresselers syndrome takes longer
550
what disorders is gout associated with
lech nehyn myleoproliferative disorders like PCV
551
first line treatment for sustained tonic clonic seziures
Benzodiazapine IV Lorazapam causes enhanced postsynaptic Cl- influx
552
most effective action of methimazole
blocks thyroid peroxidase, inhibiting the oxidation of iodide and the organification of iodine. This really helps patients symptoms it also blocks 5,-deiodinase which decreased peripheral conversion of T4 to T3
553
what metabolized a lot of toxins
cyp450 microsomal monooxygenease increased about of these can predispose a person to cancer caused by toxins
554
thorascic outlet syndrome
compression of the lower trunk of the bracheal plexus and subclavial vessels commonly because of the anterior and middle scalene muscles
555
treatment that causes cells to disintegrate when exposed to a hypotonic solution
cell wall active agents
556
virulance factor that allows e-coli to cause menengitis
K- capsular antigen it must have this to cause menengitis
557
bacillary angiomatosis
bartonella henselae in immunocompromised patients also causes cat scratch fever
558
what do dextrans adhere to?
Fibrin fibrin-platelet- aggregrates are found at sites of endothelial trauma
559
C. perfrengies toxin
lecithinase splitting of phospholipid molecules
560
cytoscopy
procedure involving the genitourinary tract that could expose you to enterococci
561
most common cause of menengitis in adults
strep pneumo
562
The only SS DNA virus
parvovirus can cause an a plastic crisis in patients with sickle cel l
563
no cardia
weakly gram + branching rod that can cause brain abcessed (ring enhancing leasion) treat with TMP-SMX
564
how dose N. Meningididis get into the CSF
pharynx ==> blood ==> choroid plexus ==> meninges
565
what causes anemia in M. pneumonia infection
cold agglutinans the anemia resolves after the infection because the immune response fades and the cold agglutinanes go away
566
neurologic symptms, renal symptoms, fever, thrombocytopenia, increases bleeding time, normal pt / ptt
thrombotic thrombocytopenic purpura ADAMTS13 (vWF metallo protease deficency) increased aggrigation and throbosis kinda looks like a prolonged veersion of DIC treat with plasmaferesis and steroids
567
classical galactosemia
Autosomal recessive
568
cyclosporin and tacrolimus
inhibit calcinurin by inhibiting calcinurin T cell proliferation is supressed these are immuno suppressants used after transplant
569
amyloid confined to the atria
consists of misfolded natriuretic peptide occurs in the elderly
570
schizotypal personality
eccentric, odd thoughts, perceptions and behavior
571
ventral pancreatic primortium guves rise to what
the main pancreatic duct
572
regular insulin
starts working in 30 min peaks in 2-4 hours lasts 5-8 hours use to long term managment of type 1 diabetes
573
bacterial DNA pol III
removes improper base pair nucleotide DURING replication
574
aids in internal rotation innervated by the thoraco dorsal nerve
latissimus dorsi
575
NF-KB
down requlated in chrones involved in cytokine production it is proiinflammatory
576
what is required to send someone to hospice
Patient has a prognosis of 6 months or less
577
umbilical hernias are due to what?
incomplete closure of the umbilical ring
578
matching studies help eleminate what
confounding because you are makeing sure both groups have a similar distribution
579
how do you treat essential tremor
propanolol follows an autosomal dominant inheratance pattern
580
sporotrichosis
Fungus that gardenders get because they get pricked by a thorn Painless raised granulomas on the prms
581
RPF equation
RBF * (1-hematocrit) need for filtration fraction FF=GFR/RPF
582
patients that undergo a total gastrectomy will need to be supplimented with what
water soluble vitamines like B12
583
sirolimus
inhibits mTOR which leads to interruption of IL-2 signal transduction

U world journal (4 decks)

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